Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Condyloma and Condyloma Acuminatum

  • Caterina Fattorini
  • Antonio Lopez-Beltran
  • Maria Rosaria RaspolliniEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-28845-1_4793-1



HPV-related exophytic papillomatous epithelial proliferation (Calonje 2011).

Clinical Features

  • Incidence

    Median of 200 affected patients per 100,000 inhabitants (male and female) (Patel et al. 2013).

  • Age

    Sexually active young adults (3rd–4thdecade), rare in older patients.

  • Sex

    Male and female adults.

  • Etiology

    Most cases (85%) are related to low-risk HPV genotypes 6 and 11. High risk genotypes (16, 18, and others) are more common in patients with multiple sexual partners.

  • Site

    Glans, coronal sulcus, foreskin, meatus, scrotum (men), and even urethra or urinary bladder (men and women) for direct extension.

  • Treatment

    Cryotherapy, laser therapy, or local surgical excision for small circumscribed lesions. Extensive surgery is required for giant destructive condylomas.

  • Outcome

    Good but recurrence is not uncommon, especially for individuals with multiple sexual partners (Thomas et al. 2017).

    Malignant transformation is very rare (Botella et al. 2000) and may occur specially in giant destructive long-standing lesions. Such lesions exhibit foci of usual squamous carcinoma especially at tumor base.


Small pink/greyish exophytic lesions are the most common presentation (condyloma acuminatum). Other possible forms are flat and giant condylomas (Amin 2016).


Microscopic examination reveals arborescent papillae with loose fibrovascular cores covered by mature squamous epithelium. Atypical cells can be found at the base of the epithelium but they are never frankly anaplastic. The tip of the papillae frequently displays parakeratosis and hyperkeratosis. Characteristic of the upper part of the epithelium are koilocytes that exhibit binucleation, wrinkled nuclei, and perinuclear halos (Fig. 1)
Fig. 1

Exophitic squamous proliferation with hyperkeratosis, prominent granular layer and cytologic features of HPV infection (perinuclear halos, binucleation, and nuclear hyperchromasia)



The epithelium that covers the papillae is positive for p53 and for high or low risk HPV (Fig. 2)
Fig. 2

HPV types 6 and 11 in urethral condyloma acuminatum. Cells containing low-risk HPV DNA by in situ hybridization (ISH), indicated by the dark-stained nuclei of superficial koilocytic cells


Molecular Features

Low-risk HPV types 6–11 on in situ hybridization and PCR investigations, other types have been infrequently reported.

Differential Diagnosis

Benign lesions:
  • Papillomatosis of the glans corona: Common papules occurring in young sexually active men. They appear as HPV negative multiple small papillomas arranged along the corona.

  • Seborrheic keratosis: HPV-negative lesions characterized by parakeratosis and acanthosis; no koilocytes are found.

Malignant and premalignant lesions:
  • PeIN (Penile Intraepithelial Neoplasia): This premalignant lesion may simulate flat condyloma. PeIN can be classified in differentiated forms, negative for HPV or p16, and HPV-related forms.

  • Warty Carcinoma: HPV-related carcinoma whose cells display pleomorphism, p16 positivity and carry high-risk HPV genotypes. It may be confused with giant condylomas.

  • Papillary carcinoma and verrucous carcinoma: Non-HPV-related carcinomas that may simulate condylomatous papillae. The tumor base is infiltrative in papillary subtypes and broad in verrucous subtypes (like in condylomas). HPV and p16 expression is negative in both lesions.

References and Further Reading

  1. Amin, M. B. (2016). Diagnostic pathology: Genitourinary. Philadelphia: Elsevier.Google Scholar
  2. Botella, E., Burgués, O., et al. (2000). Warty carcinoma arising in condyloma acuminatum of urinary bladder: A case report. International Journal of Surgical Pathology, 8(3), 253–259.CrossRefGoogle Scholar
  3. Calonje, E. (2011). Mckee’s pathology of the skin. Amsterdam: Elsevier.Google Scholar
  4. Patel, H., Wagner, M., et al. (2013). Systematic review of the incidence and prevalence of genital warts. BMC Infectious Diseases, 13, 39–39.CrossRefGoogle Scholar
  5. Thomas, R., Steben, M., et al. (2017). Recurrence of human papillomavirus external genital wart infection among high-risk adults in Montréal, Canada. Sexually Transmitted Diseases, 44(11), 700–706.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Caterina Fattorini
    • 1
  • Antonio Lopez-Beltran
    • 2
    • 3
  • Maria Rosaria Raspollini
    • 1
    Email author
  1. 1.Histopathology and Molecular DiagnosticsUniversity Hospital CareggiFlorenceItaly
  2. 2.Pathology ServiceChampalimaud Clinical CenterLisbonPortugal
  3. 3.Unit of Anatomic Pathology, Department of SurgeryCordoba University Medical SchoolCordobaSpain